Chronic solar damage is the principal aetiological factor in AK and BD.8,14-16 People with light complexions, blue eyes and childhood freckling are at highest risk given their innate lack of protective pigment.3 Individuals with compromised immunity, such as organ-transplant recipients, with diminished or absent melanin, such as albinos, with decreased capacity to repair ultraviolet-induced damage, such as persons with xeroderma pigmentosum, all demonstrate increased risk for AK. Risk factors for BD include arsenic exposure,17-20 immunosuppression,21 and human papillomavirus (HPV), particularly HPV-16 in anogenital lesions.22,23

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